Each fall, I welcome students from Johns Hopkins University School of Medicine into my home. Hopkins is one of only 10 "orphan" medical schools that lack a department of family medicine, so the student leaders of its primary care interest group diligently fan whatever sparks of interest in primary care they can find among their classmates.
Joey Nichols, M.D.
Our annual potluck, at my rowhouse a few blocks away from their medical school, is a rare opportunity for these students to mingle informally with family physicians. I open the evening with a variation on an activity I have used many times, including with community health workers in Honduras and with hospital executives in Boston. Each student is asked to record their "hopes, fears and expectations" for a career in family medicine on color-coded sticky notes. The only rule is that once a note goes on the wall, it belongs to everyone. We sort the sticky notes into themes and discuss as a group.
Each year, several students fear they will not be able to master all the knowledge necessary to practice primary care, while others hope they will. Many expect their long-term relationships with their patients will be the most important aspect of their careers. This year, for the first time, a few sticky notes revealed fears about physician burnout.
When asked how I deal with burnout, I explain that everyone copes differently. I found satisfaction with a dual career in clinical practice and innovation, which for me means executing novel ideas, or old ideas in a novel setting, in a way that adds value.
This exercise expands the set of possibilities in a room. It works so well because the hopes, fears and expectations it elicits from participants map to the three triggers of innovation:(timkastelle.org) fantasy, fear and frustration. Usually I use this exercise to open a design session, when a diverse group of people gather to solve a difficult problem, like building a software feature or planning a community health program. Tapping into your hopes/fantasies, fears and expectations/frustrations can illuminate ways for you to create value in your immediate surroundings and for family doctors to expand the possibilities for our specialty.
We all fantasize about how our work could be improved. Most of the time, this amounts to little more than daydreams that dissolve as quickly as they appear. Some of us have the discipline, the patience and the skills to turn the hopes embodied by our daydreams into realities. If you do, then what are you waiting for? Do you know the people you would need to implement your vision? If not, then in today's connected world, they cannot be hard to find.
Fear can be a powerful motivator. The pressures we feel to see more patients in less time, respond to burdensome requests for data and justify the care we deliver can be a powerful source of creativity. What changes, if made on a systemic level, might alleviate this fear that you are experiencing? Is there a tool you need that does not exist? Is there a policy change that would help you sleep better at night? If so, what could you do tomorrow to bring it one step closer to existence?
When one's expectations go unmet, frustration often ensues. Designers and entrepreneurs talk about "pain points" -- real or perceived problems they solve to create value. There is a remarkable industry of caring -- although sometimes misinformed -- entrepreneurial types who want to make health care better. They desperately need to hear from the physicians who are close to the problems they are trying to solve.
Some of us are retreating from clinical practice as a response to burnout. Perhaps some of the activities we cling to are worth letting go of, and there may be ways we would like to help our patients that seem impossible with the tools we have available today. We are all, in this moment, answering the question that was asked a few short years ago: "What will the work of the family physician look like in the 21st century?" We will have to find ways to adapt. Some of us will become employed. Some will participate in novel practice models like telemedicine or direct primary care. Some will find side careers(passiveincomemd.com) related to medicine as consultants, entrepreneurs or investors. Some will change careers(www.medscape.com) entirely.
With the help of the AAFP, I have found ways to maintain my clinical practice while working to solve some of the bigger problems with health care information technology. As a delegate to the recent National Conference of Constituency Leaders, I have advocated for changes in medical education that will help physicians in practice and in training make the best use of emerging technologies, while protecting our patients from harm along the way. As the AAFP's Alliance for e-Health Innovation Primary Care Innovation Fellow, I have explored ways the Academy can help free physicians from our toil as data entry clerks and to put health data to use.
I am motivated to do this by my daughter Annalise. She has her mother's kind heart and thirst for adventure. She inherited her father's stubbornness and urge to tinker. Hers will not be an easy life. She will take on battles she does not need to fight, in the name of helping people naysayers claim are beyond help. She has already decided her career plans, and she reiterates them regularly: "Daddy, when I grow up, I'm going to be taller than you. And I'm going to be a doctor, just like you."
She will be taller because she will stand on my shoulders, and the shoulders of all of us who are working today to reshape our profession to weather the demands of an uncertain future. "No, baby. You will be taller than me. And you'll be a better doctor."
Joey Nichols, M.D., (class of 2011) lives with his daughter Annalise (M.D. class of 2041), his newborn daughter Teagin (who has yet to declare a career path), and his wife, Erin (Ph.D. class of 2009), in Baltimore. He practices as a family medicine virtualist and works as a primary care innovator. He is the 2017 inaugural Family Medicine Innovation Fellow of the AAFP Alliance for e-Health Innovation.